Quality Improvement & Data Systems for Performance

ExcellenceBoard and Executive Learning Series

June 2, 2012

Lucy A. Savitz, Ph.D., MBADirector of Research and

Education

Institute for Health Care Delivery Research

The Quality Challenge“the difference between the care we deliver and the care

we could deliver”

The Right Care

For The Right Person

At The Right Time

Care Delivery Falls Short of Potential

• Well-documented, massive variation in practices

• High rates of inappropriate care

• Unacceptable rates of preventable care-associated patient injury & death

• A striking inability to do what we know works

• Huge amounts of waste (>44%), spiraling prices, and limited access

Need for a Healthcare System that Learns

We require a sustainable system

• That gets the right care to the right person at the right time

and then

• Captures the results for making improvements.

Mission Critical Support for Performance Excellence

Training Clinical Integration

Foundation for Robust QI &

Delivery Science Research

Data Systems

Driving Change

• We combined our QUE “research” experience with Deming’s quality theory to create a series of training programs.

ATP Training, 1992-present

• 500+ Intermountain Staff

• 1,800+ External Participants

Training used to drive culture change.

Brent James, MD, M.Stat. , Chief Quality OfficerDirector and Founder; Institute for Health Care Delivery Research

Clinical Integration

• Clinical work process-based organizational structure

• A fundamental idea of QI theory is to identify key work processes then organize around them.

• A limited number of these key processes make up the majority of services you provide to patients.

Integrated Reporting and Analysis

EDWEDWFinancial

Data

FinancialData

Clinical Data

Clinical Data

Claims&Eligibility

Claims&Eligibility

Data Systems

HELP

Pharmacy Pharmacy

Radiology Radiology

Data Entry(CW)

& Results Review

EventMonitor

Billing &Financial

MedicalLogic

Modules

Medical Dictionaries

Database

Research& Analysis

(EDW)Patient Care

Database(CDR)

DatabaseInterface

LaboratoryLaboratory

2

InsurancePlans

Case for Continuous Improvement

Incorporating

• Innovation

• Disciplined QI

• Research & Evaluation

Critical to finding new designs/solutions for optimizing:

• Patient experience

• Health of the population

• Controlling cost/reducing waste.

The Problem

Reducing variation in compliance with evidence-based guidelines.

• Care Process Models (CPMs) are narrative documents that aim at representing state-of-the-art medical knowledge.  

• Clinical Decision Support Tools can include all ways in which health care knowledge is represented in health information systems.

Key steps in our approach…

• Identify problem• Establish evidence base• Develop, test, & implement using QI

concepts and tools (define, measure, analyze, improve, control)

Institute for Health Care Delivery Research: Staffing

Leadership: 3.0 FTEs

Brent James, MD, M.Stat.; Executive Director

Lucy Savitz, Ph.D., MBA; Director, Research & Education

Todd Allen, MD; Assistant Quality Officer

Support Staff:

• Clinical Program Analysts: 13.25 FTEs

• Education Program Staff: 4.25 FTEs

• Program Support Staff: 4.5 FTEs

• Interns/Fellows: 3.0 FTEs

Core Functions of the Institute—supporting a Learning Commons

1. QI Training

2. Clinical Program Support, data examination to create the learning organization

3. Delivery System Transformation Support

4. Operationally Meaningful Research

5. Collaborations

6. Dissemination & Shared Learning

Scientific Approach to QIIOM: Selker, H et al., 10/11.

• Clear, measurable process & outcomes goals

• Basis in evidence

• Iterative testing

• Appropriate analytic methods

• Documented results

QI: Role in Driving Evidence Base

QI

ImplementationScience

ProgramEvaluation

Qausi-experimental

InterventionStudies(Trials)

Clinical Effectiveness

Outcomes

Driving the science of change/innovation…

Selected References

• Wallace, J, LA Savitz: Estimating Waste in Frontline Health Care Workers, Journal of Evaluation in Clinical Practice, 14:178-180, 2008.

• Clark, DD, LA Savitz, SB Pingree: “Cost Cutting in Health Systems Without Compromising Quality,” Frontiers of Health Services Management, 27(2):19-30, 2010.

• James, BC & LA Savitz: “How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts,” Health Affairs, 30(6), 2011.

• Selker, H, C Grossman, A Adams, D Goldman, C Dexii, G Meyer, V Roger, L Savitz, R Platt: “The Common Rule and Continuous Improvement in health Care, A Learning System Perspective, IOM, October, 2011.

• Luther, K & LA Savitz: “Leaders Challenged to Reduce Cost, Deliver More,” Healthcare Executive, Jan/Feb, 2012.

Thank you.